Wells’syndrome possibly caused by hematologic malignancy,influenza vaccination or ibrutinib:A case report

作     者：Mihela Šajn Boštjan Luzar Samo Zver 

作者机构：Department of HematologyUniversity Medical Centre LjubljanaLjubljana 1000Slovenia Institute of PathologyMedical Faculty LjubljanaLjubljana 1000Slovenia Medical FacultyUniversity of LjubljanaLjubljana 1000Slovenia 

出 版 物：《World Journal of Clinical Cases》 (世界临床病例杂志)

年 卷 期：2022年第10卷第30期

页      面：10997-11003页

核心收录：

学科分类：1002[医学-临床医学] 100214[医学-肿瘤学] 10[医学] 

主　　题：Wells’syndrome Chronic lymphocytic leukemia Allogenic hematopoietic stem cell transplantation Ibrutinib Thimerosal-containing influenza vaccine Clinical case Case report 

摘      要：BACKGROUND Wells’ syndrome(eosinophilic cellulitis) is an uncommon eosinophilic dermatosis of uncertain pathogenesis,characterized by clinical polymorphism and suggestive but nonspecific histopathologic traits.Its course is recurrent,and response to therapy is unpredictable.In a case in which the patient has a number of potential triggers for the manifestation of Wells’ syndrome skin rash,the treating physician must decide or must make an assumption in order to establish the most likely clinical scenario.This is important for the patient’s future treatment plans.CASE SUMMARY We describe the clinical case of a 46-year-old female with chronic lymphocytic leukemia who had already received treatment for several months with ibrutinib.She was diagnosed with Wells’ syndrome 10 d after an influenza vaccination containing thimerosal.Based on the literature,the patient was treated with a course of oral steroids.Resolution of clinical symptoms and rash were observed in response to the treatment.Ibrutinib was not discontinued.CONCLUSION The etiology of Wells’ syndrome remains unknown.Clinically,it resembles bacterial cellulitis.Lack of response to antibiotic treatment should lead the physician to consider a diagnosis of Wells’ syndrome.Treating the underlying condition is important and may lead to resolution of the syndrome.However,the most common and effective treatment to limit the course of the disease are systemic steroids.